Some 1.6 million people in the U.S. live with limb loss, according to a 2008 study, and that number could more than double by 2050. Modern prostheses enable replacements of limbs lost to injury or disease. But people who lose functionality in an otherwise healthy arm or leg have had few options. A team of surgeons in Vienna, Austria, however, recently developed bionic reconstructions of the hands of 16 people who had lost manual control and sensation because of nerve damage. The catch: patients have to undergo a nonessential amputation of the damaged hand to make room for the prosthesis.

Hoping to clarify the choices and considerations, surgeon Laura Hruby and her colleagues at the Medical University of Vienna in Austria published a protocol for selecting the first patients to undergo this intensive procedure and guiding them through it.

The Vienna team focused on people with damage to the brachial plexus, the cluster of nerves that controls muscles in the shoulders, arms and hands. “Bionic hand reconstruction in patients with brachial plexus lesions, in whom classic primary and secondary reconstructions have failed, gives hope to patients who have lived without hand function for years or even decades,” Hruby says.

The approach improved hand dexterity beyond what would be possible with surgical intervention, according to the research, which was published online in January in the Journal of Neurosurgery. It also reduced the severe, spontaneous pain that can develop in limbs that sustain nerve damage.

STEPS TOWARD RECONSTRUCTION

1. Bionic hands are mounted adjacent to the original hand onto an arm brace and wired to electrodes that can pick up the candidate’s functional forearm nerves through the skin. This stage gives people practice controlling the prosthesis.

2. The original hand is surgically removed.

3. After recovery from surgery, the bionic hand is moved from its temporary position on the arm brace to the end of the candidate’s wrist.

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